Abstract

PURPOSEEvaluation of stability and functional response after riboflavin-UVA–induced cross-linking
in a population of patients younger than 18 years with progressive keratoconus after
36 months of follow-up.METHODSProspective nonrandomized phase II open trial conducted at the Department of Ophthalmology,
Siena University, Italy. The "Siena CXL Pediatrics" trial involved 152 patients aged
18 years or younger (10–18 years) with clinical and instrumental evidence of keratoconus
progression. The population was divided into 2 groups according to corneal thickness
(>450 and <450 μm) at the time of enrollment. The riboflavin-UVA–induced corneal cross-linking
was performed in all patients according to the standard epi-off protocol. Parameters
recorded preoperatively and postoperatively were as follows: uncorrected visual acuity,
best spectacle–corrected visual acuity, corneal topography and surface aberrometry
(CSO Eye Top topographer; Florence, Italy), optical pachometry (Visante OCT; Zeiss
Meditec, Jena, Germany), and HRT II confocal microscopy (Rostock Cornea Module, Heidelberg,
Germany).RESULTSFunctional data at 36 months showed an increase of +0.18 and +0.16 Snellen lines for
uncorrected visual acuity and best spectacle-corrected visual acuity, respectively,
in the thicker group (corneal thickness >450 μm) and +0.14 and +0.15 Snellen lines,
respectively, in the thinner group (corneal thickness <450 μm). Patients in the latter
group already showed a better and faster functional recovery than the thicker group
at 3-month follow-up. Topographic results showed statistically significant improvement
in K readings and asymmetry index values. Coma reduction was also statistically significant.CONCLUSIONSThe study demonstrated significant and rapid functional improvement in pediatric patients
younger than 18 years with progressive keratoconus, undergoing riboflavin-UVA–induced
cross-linking. In pediatric age, a good functional response and keratoconus stability
was obtained after corneal cross-linking in a 36-month follow-up.